COVID-19 患者的肾脏损伤发生率及其与危重症和死亡的关系。
Prevalence of Kidney Injury and Associations with Critical Illness and Death in Patients with COVID-19.
机构信息
Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China.
Department of Cardiology, National Clinical Research Center for Infectious Disease, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, China.
出版信息
Clin J Am Soc Nephrol. 2020 Nov 6;15(11):1549-1556. doi: 10.2215/CJN.04780420. Epub 2020 Sep 17.
BACKGROUND AND OBJECTIVES
Coronavirus disease 2019 is spreading rapidly across the world. This study aimed to assess the characteristics of kidney injury and its association with disease progression and death of patients with coronavirus disease 2019.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This is a retrospective study. Two representative cohorts were included. Cohort 1 involved severe and critical patients with coronavirus disease 2019 from Wuhan, China. Cohort 2 was all patients with coronavirus disease 2019 in Shenzhen city (Guangdong province, China). Any kidney injury was defined as the presence of any of the following: hematuria, proteinuria, in-hospital AKI, or prehospital AKI. AKI was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) creatinine criteria. The primary outcome was death at the end of follow-up. The secondary outcome was progression to critical illness during the study period.
RESULTS
A total of 555 patients were enrolled; 42% of the cases (229 of 549) were detected with any kidney injury, 33% of the cases (174 of 520) were detected with proteinuria, 22% of the cases (112 of 520) were detected with hematuria, and 6% of the cases (29 of 520) were detected with AKI. Of the 29 patients with AKI, 21 cases were recognized as in-hospital AKI, and eight were recognized as prehospital AKI. Altogether, 27 (5%) patients died at the end of follow-up. The death rate was 11% (20 of 174) in patients with proteinuria, 16% (18 of 112) in patients with hematuria, and 41% (12 of 29) in the AKI settings. Multivariable Cox regression analysis showed that proteinuria (hazard ratio, 4.42; 95% confidence interval, 1.22 to 15.94), hematuria (hazard ratio, 4.71; 95% confidence interval, 1.61 to 13.81), and in-hospital AKI (hazard ratio, 6.84; 95% confidence interval, 2.42 to 19.31) were associated with death. Among the 520 patients with noncritical illness at admission, proteinuria (hazard ratio, 2.61; 95% confidence interval, 1.22 to 5.56) and hematuria (hazard ratio, 2.50; 95% confidence interval, 1.23 to 5.08) were found to be associated with progression to critical illness during the study period.
CONCLUSIONS
Kidney injury is common in coronavirus disease 2019, and it is associated with poor clinical outcomes.
PODCAST
This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2020_09_18_CJN04780420.mp3.
背景与目的
新型冠状病毒病（COVID-19）正在全球迅速传播。本研究旨在评估肾脏损伤的特征及其与 COVID-19 患者疾病进展和死亡的关系。
设计、地点、参与者和测量：这是一项回顾性研究。纳入了两个有代表性的队列。队列 1 纳入了来自中国武汉的重症和危重症 COVID-19 患者。队列 2 纳入了深圳市（中国广东省）所有 COVID-19 患者。任何肾脏损伤定义为存在以下任何一种情况：血尿、蛋白尿、院内 AKI 或院前 AKI。AKI 根据肾脏病改善全球结局（KDIGO）肌酐标准定义。主要结局是随访结束时的死亡。次要结局是在研究期间进展为危重症。
结果
共纳入 555 例患者；42%（229/549）的病例检测到任何肾脏损伤，33%（174/520）的病例检测到蛋白尿，22%（112/520）的病例检测到血尿，6%（29/520）的病例检测到 AKI。在 29 例 AKI 患者中，21 例为院内 AKI，8 例为院前 AKI。共有 27 例（5%）患者在随访结束时死亡。蛋白尿患者的死亡率为 11%（20/174），血尿患者为 16%（18/112），AKI 患者为 41%（12/29）。多变量 Cox 回归分析显示，蛋白尿（危险比，4.42；95%置信区间，1.22 至 15.94）、血尿（危险比，4.71；95%置信区间，1.61 至 13.81）和院内 AKI（危险比，6.84；95%置信区间，2.42 至 19.31）与死亡相关。在入院时非危重症的 520 例患者中，蛋白尿（危险比，2.61；95%置信区间，1.22 至 5.56）和血尿（危险比，2.50；95%置信区间，1.23 至 5.08）与研究期间进展为危重症相关。
结论
COVID-19 中肾脏损伤很常见，与不良临床结局相关。
播客
本文包含一个播客，可在 https://www.asn-online.org/media/podcast/CJASN/2020_09_18_CJN04780420.mp3 上找到。
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